Provider Demographics
NPI:1629108063
Name:SOUTHTOWNS RADIOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SOUTHTOWNS RADIOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-649-9000
Mailing Address - Street 1:3040 AMSDELL RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5835
Mailing Address - Country:US
Mailing Address - Phone:716-649-9000
Mailing Address - Fax:
Practice Address - Street 1:3040 AMSDELL RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5835
Practice Address - Country:US
Practice Address - Phone:716-649-9000
Practice Address - Fax:716-649-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCE8352OtherRAILROAD MEDICARE
NY00026681804OtherUNIVERA
NY040426000332OtherFIDELIS
NY03069821Medicaid
NY000508387008OtherBCBS WESTERN NY
146156FFOtherPREFERRED CARE
NY03069821Medicaid
NY03069821Medicaid